A couple presents with 2 years of primary infertility. The woman has regular cycles and normal hormonal profile; semen analysis is normal. Hysterosalpingography reveals bilateral proximal tubal occlusion. Which investigation is the most appropriate next step to confirm tubal patency?

• A Repeat HSG after 3 months
• B Hysteroscopic tubal cannulation as primary treatment
• C Saline infusion sonography
• D Laparoscopy with chromopertubation ✓

Explanation

Laparoscopy with chromopertubation (dye test) is the gold standard for assessing tubal patency and is indicated when HSG shows proximal tubal occlusion. HSG has a false-positive rate for proximal occlusion of up to 20% due to tubal spasm. Laparoscopy confirms patency and simultaneously evaluates the pelvis for endometriosis or adhesions. Hysteroscopic cannulation may be therapeutic but is performed after diagnostic confirmation.

Reference: Te Linde's Operative Gynecology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.